地塞米松联合异烟肼鞘内注射治疗结核性脑膜炎临床疗效

2019-09-02张嘉麟赵利民

中国现代医生 2019年18期

张嘉麟赵利民

[摘要] 目的研究地塞米松與异烟肼鞘内联合注射治疗结核性脑膜炎的临床效果。方法选取2017年3月～2018年3月于我院结核内一科入院的结核性脑膜炎患者120例，按随机数字表法分为观察组62例和对照组58例，两组均给予常规HRZE治疗方案强化治疗3个月，而后改成6个月的口服HR，对照组每周一次鞘内注射地塞米松5 mg，观察组每周一次鞘内注射异烟肼0.1 g及地塞米松5 mg。比较两组临床疗效及临床转归时间，记录两组患者治疗前后脑脊液常规，对比脑脊液生化指标改善情况，比较两组不良反应情况。结果治疗3个月后，观察组总有效率为85.48%，对照组总有效率为74.14%，观察组疗效优于对照组（χ2=7.825，P=0.020）。观察组脑脊液氯化物和葡萄糖升高较对照组显著，细胞个数和蛋白质含量下降较对照组明显（P<0.05），生化指标恢复时间明显少于对照组。观察组临床症状转归时间短于对照组，差异具有统计学意义（P<0.01）。结论鞘内注射地塞米松联合异烟肼治疗结核性脑炎，可显著转归临床症状，改善脑脊液循环，提高临床疗效。

[关键词] 结核性脑膜炎;地塞米松;异烟肼;鞘内注射

[中图分类号] R529.3 [文献标识码] B [文章编号] 1673-9701（2019）18-0086-03

[Abstract] Objective To study the clinical effect of dexamethasone combined with isoniazid intrathecal injection in the treatment of tuberculous meningitis. Methods A total of 120 patients with tuberculous meningitis admitted to the first department of tuberculosis of our hospital from March 2017 to March 2018 were enrolled. The patients were divided into two groups according to the random number table， including 62 cases in the observation group and 58 cases in the control group. Both groups were given intensive treatment with conventional HRZE regimen for 3 months， then changed to 6 months of oral HR. The control group received intrathecal injection of 5 mg of dexamethasone once a week. The observation group received an intrathecal injection of 0.1 g of isoniazid and 5mg dexamethasone once a week. The clinical efficacy and clinical outcome time of the two groups were compared. The cerebrospinal fluid routine of the two groups was recorded before and after treatment. The improvement of biochemical indicators of cerebrospinal fluid was compared and the adverse reactions of the two groups were compared. Results After 3 months of treatment， the total effective rate was 85.48% in the observation group and 74.14% in the control group. The effect of the observation group was better than that of the control group（χ2=7.825， P=0.020）. The increase of chloride and glucose in the cerebrospinal fluid of the observation group was significantly higher than that of the control group. The decrease of cell number and protein content of the observation group was significantly higher than that of the control group（P<0.05）， and the recovery time of biochemical indicators of the observation group was significantly less than that of the control group. The clinical symptoms outcome time of the observation group were shorter than those of the control group， and the difference was statistically significant（P<0.01）. Conclusion Intrathecal injection of dexamethasone combined with isoniazid for tuberculous Mmeningitis can significantly reduce clinical symptoms， improve cerebrospinal fluid circulation， and improve clinical efficacy.

综上，地塞米松联合异烟肼鞘内注射治疗结核性脑炎，可显著改善脑脊液循环，转归临床症状，对提高疗效、改善预后有重要意义。但需要注意的是，地塞米松在结核性脑炎临床治疗中，使用疗程、剂量及减量的方法仍存有争议。

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